Mental Care for Children after Disasters
for Teachers and School Nurses

Shizuoka UniversityPreface
Ｔhe necessity of "mental care" has become apparent for anyone who
has suffered from an artificial or natural disaster such as the Great
Hanshin Awaji Earthquake. The wide range of mental health problems
experienced by local residents is proof of this necessity. Numerous
practices have been put in place to provide them with this mental healthcare. In the damaged areas, mental health care workers are asked tocollaborate and engage in activities with the local communities.
Because mental health care is a critical issue during a disaster, theShizuoka University Disaster Prevention Center takes steps to beprepared, including conducting research, practicing mental health care,and educating people in the local community.
We have published this brochure for teachers and school nurses fromelementary and junior high schools as a part of our activities. Incollaboration with the Shizuoka Prefecture Clinical Psychologist
Association, this brochure has been created to provide basic information
on mental health care for children and students in case of a disaster.
We appreciate your use of this brochure and we would value any
feedback.
Oki Naotaka
President of Shizuoka University
January 2010

Exposure to disasters
During a disaster, you may be exposed to various
stresses such as a fear of death or the loss of asignificant person or thing. Wide-ranging reactions tostress may occur after the disaster.
１ Stress from fear or shock → Trauma reaction
２ Stress from the loss of an important person, thing,placeStress from the loss , or memory → Loss reaction
３ Stress from continuing anxieties such as a change inliving situation, a difficult stay in evacuation shelters, andworries about rebuilding a new life, such as securing
a job and a house → Stress reaction from daily life

What is caused by stress?
The problematic symptomsof stress don't appear
because I have theemotional capacity to deal
with them.

Becoming stressful
Mental limitation
Extra capacity to handle stress“I am OK
because I havethe capacity tohandle
everything!”

ReleasingstressnormallyIf you have too much stress,
you may lose the ability todeal with it because it exceeds
your mental limitations.

What is caused by stress?
Disaster causes
enormous stress andhorrible shock

Various symptoms occur
in your mind and body.
＜Stress Reaction ＞“I feelterrible.”

You can’treleasestressnormally.

Various stress reactions
Body
・Waking up often ordifficulty sleeping
at night
・Having no appetite
・Having a stomachache
or a headache・Feeling tired

Behavior
・Becoming restless
・Frolicking (becometoo excited)
・Becoming
short-tempered
・Becoming childish
・Social withdrawal

Feelings
・Scared and Worried・Irritated・Depressed
・Loss of emotion
・Loss of motivation
・ Lonely

Thought process・Loss of concentration
・Having difficulty
gathering thoughts
・Remembering someevents suddenly
・Having difficulty
remembering
・Becoming forgetful・Self-reproachful thinking

The stress reaction in the body
① Sleeping problems
・Difficulty falling asleep
・ Fearful dreams or crying during the night・ Waking up many times during the night
・ Not feeling rested② Eating problems
・ Loss of appetite
・ Overeating
・ Meals don’t taste good

③ Other problems
・ Stomachache or feeling nauseous・ Constipation or diarrhea lasting many days
・ Headache or feeling heavy-headed
・ Feeling tired・ Feeling suffocated・ Feeling like your body is always shaking

Behavioral Reactions① Becoming restless or too excited・Fidgeting or moving around needlessly
・Becoming over-excited or hyperactive② Becoming short-tempered
・Getting angry easily
・Becoming violent (such as being aggressive or
breaking things)③ Becoming childish
・Wanting to cling to parents and sleep with them・Refusing to do things they used to do alone
such as going to the bathroom, taking a bath,or changing clothes
・ Becoming unreasonable・Wetting the bed④ Social withdrawal・Staying at home (and not going out)
・Refusing to go to school or workEmotional Reactions① Fear or anxiety
・Feeling nervous and scared by sounds or dark places.
・Feeling scared to be alone and anxious without reason.

② irritation
・Becoming irritated easily.
・ Always feeling grouchy.
・ Feeling like you always have to do something.

③ Depression
・Feeling down and depressed.
・Feeling sad and crying suddenly.

④ Loss of emotion
・Rarely feeling either happy or sad.

⑤ Loss of motivation
・No desire to do anything, even the things
enjoyed before.

⑥ Loneliness・ Feeling all alone.

Thought Process Reactions① Loss of concentration
・Inability to concentrate on schoolwork or play.
・Feeling of spacing out or always thinking about other things.

② Difficulty gathering ideas
・Feeling anxious and having a hard time organizing ideas.
・Difficulty making decisions due to lack of confidence in ideas.
・Thinking negatively.

③ Remembering some events suddenly・ Suddenly remembering some events from the disaster.
・ Seeing something reminiscent of the disaster andexperiencing the same feelings that occurred at that time.

④ Inability to remember things from the disaster or
becoming forgetful
・ Recall of some events from the disaster is unclear.
・ Recent events are easily forgotten.

⑤ Blame・ Feeling like the disaster was due to some personal fault.

What are stress reactions?
❐ They are natural reactions one has after

receiving an abnormal shock.
Anyone can have these reactions.
However, the level and signs of the reactions are different
depending on the person.
❐ They will gradually decrease as you

continue to have a secure and safe life.
Try to relax and organize the rhythm of yourlife as much as possible.

Differences between younger and older children
The signs of a stress reaction are different depending on age.

❐ Characteristics of elementary school children
・They want to cling to their parents and their behavior
may regress.
・They fidget and become restless.
・They sometimes say things that differ from reality.
❐ Characteristics of junior high school students
・They tend to feel depressed and show bodily
symptoms.
・They avoid relationships with friends and sometimes
refuse to go to school.
・They show poor performance at school.
・They sometimes become delinquent and violent.

Characteristics of the person
who has a strong stress reaction
The signs of a stress reaction differ depending on the person, even
if s/he is exposed to the same disaster.
The appearance of a strong stress reaction may be characterized
by the following points. Let the child consult with a person who
can be trusted.
❐ They were very frightened or lost an important person or things in adisaster.
❐ They were trapped in a collapsed building or house for a long time.
❐ They are by nature easily scared or a worrier.
❐ They had difficulty socializing with others before the disaster.
❐ They have a fear of school, a tendency to anger easily, ora developmental disorder (specifically a tendency towards autism).
❐ They don’t have enough support from their family or other people.
❐ They had a shocking experience before the disaster.

How to deal with stressHow to reduce stress reactions❐ Secure and safe feelings
Children feel better and cheer up when they have a time and place
where they can communicate and laugh with others.
❐ An emotional bond with other people
They should try to strengthen the bonds they have withpeople they are close to, like friends and family, to help
remind them that they are not alone.
They can build close ties with others through study, work, andactivities in their communities.
❐ Expression of feelings
They should be encouraged to freely express true feelings, suchas sadness, anger, frustration, happiness, and so on.
They don’t have to hold back tears and pretend to be OK.
They should not be forced to express their feelings.

How to deal with children who have stress reactions
 Scolding and encouraging are forbidden
Statements like “Do not complain,” “Do your best,” or “You'll forget itsoon” make it hard for children to express their feelings easily andcauses their stress reactions to linger longer.

 Let children express their feelings in a safe and secureenvironment
It is important for the family and the teachers at school to let thechild express their feelings normally.
Keep in mind that stress reactions are natural and transient.

 Go to a medical agency if necessary
Consult a medical agency if the child becomes severely confused orif symptoms like sleeplessness or anorexia persist for more thana month.

Teachers are victims as well
A teacher should understand his/her own stress
reactions, prepare for long–term effects froma disaster, and rest as much as possible.

❐ Be careful not to collapse due to fatigue.
❐ Try to rest as much as you can.
❐ Sleep and eat regularly to handle the fatigue from hardwork.
❐ Don’t carry the burden all by yourself, but talk with yourboss and colleagues instead.
❐ Take time to relax once a day (taking time for tea, a bath,a nap, and so on).

Life after the disaster
Immediately after the disaster, you feel tense and can exert all yourstrength without a rest.
However, you may suddenly get sick because you have become
exhausted without noticing.
Try to “eat, sleep, and talk to someone” when you feel stressed.

① Take a rest frequently.
・Decide the time to take a nap.
・Take a relaxing bath when possible.

② Sleep more than 5 hours a day.
・Lie down to rest your body even if you cannot
sleep.

③ Eat and drink sufficiently
・ Don’t forget to eat meals regularly.
・ Try to eat something even if you have no appetite.

④ Be careful about drinking too much alcohol.
・ Try not to depend on alcohol when you feel anxious and can’t sleep
because you risk becoming an alcoholic.

⑤ Talk with someone if you feel anxiety.
・ Anyone can feel anxious and get sick after a disaster.
Take time to chat with someone you can trust when you feel anxious.

What to do in such a case?
Children feel relaxed and recover feelings of safety andcheerfulness when adults treat them with a calm andwarm attitude.
❐ No appetite
・Let them eat or drink whatever they can at the time, without forcing
them.
・Let them drink fluids frequently even if they have no appetite.
❐ Can’t sleep or wake up at night・Don’t scold the child・Sleep together with the child.
・Make the room a little brighter.
・Consult with a medical agency if they cannot sleep for more thana week.

❐ Complaining about health problems
Giving children first-aid treatment that eases their pain, even if only
for a short while, and listening to them talk lets children feel more atease.
In addition, it is important to go to a medical institution if necessary.
❐ Talk repeatedly about the disaster
Even adults are likely to feel uneasy and say “forget about it” when
they hear the same story many times, but children’s
mental pain is healed when adults calmly listen to them talk.
Acknowledge the children’s feelings and say
something like “It’s hard to remember
such painful events, isn't it?”What to do in such a case?
❐ Playing disaster game
Although it may seem inappropriate, children’s pain can be healed byplaying a disaster game. Don't stop them, but tell them something
considerate such as, “You were shocked by such a huge earthquake.
That was terrible, wasn’t it?” However, when children can’t stop
the game by themselves even if they feel pain, invite them to playsomething else.
❐ Clinging to you like a small child
It is okay to interact with them as usual, so take some time to play withthe children.
By spoiling them a little, their hearts are healed and little by little theyregain their cheerfulness.

❐ Blaming themselves
Sometimes children tend to think “I did something wrong and as
punishment I experienced a disaster.”
You should tell them it was a natural disaster and praise them for theirefforts, hard work, and good points.
❐ Excessive hyperactivity and behaving as if nothing happened
Both express children's efforts to cope with the disaster, although they
have difficulty accepting it in their minds. Say something like “It’shard, isn’t it?” and look after them.

What to do in such a case?
❐ Worrying that one's stress reactions are different from others’
Some children think they’re strange when their stress reactions aredifferent from others’.
Tell them, “It’s natural that stress reactions are different for eachperson. It will not continue for a long time.”
Consult with a medical agency when the symptoms continue for morethan a month.
☑ Point
When children see a lot ofscenes of the disasterthrough media such as TV,
they become more anxious.
Take the news time into
consideration, and make ita time to play.

Care in school life
We can utilize the characteristics of a teacher for care in school life.
❐ Reach out to and converse with children frequently
Children’s minds calm down through resuming an ordinary everyday
life, such as seeing each other, exchanging greetings, and having
normal conversations.
❐ Notice changes in children’s condition
Although children may seem okay, sometimes they have a serious
mental wound and a sense of loss.
Observe the mental state of the children carefully.
❐ Mental care through playing and working
Children can ease the tension in their minds by feeling an “emotionalbond” with other people through playing and working together.

Points to remember about care in school life
❐ Take age into consideration when coping with children
・Older children are less likely to show stress symptoms.
Reach out to them while paying attention to small changes in theircondition.
・Interact with them according to their ages.
❐ Observe their changes over a long period of time・Sometimes stress symptoms appear delayed and may evenoccur exactly one year after a disaster. We need to observe theprogress of children’s condition for several years.
❐ Cooperate with parents, experts, and medical agencies
・At home, a different reaction from those observed at school mayappear. Keep in touch with parents.
・Consult with an expert and a medical agency if the child shows
symptoms for more than a month or if the condition becomes worse.

Breathing Relaxation① Sit upright and naturally in a comfortable position.
You can close your eyes or leave them open.
② Inhale deeply, easily, and comfortably into yourabdomen.
③ Breathe slowly in through your nose and out fromyour mouth.
④ Again, breathe in, count 1,2,3, pause a little, breatheout, count 6,7,8,9,10 ～.
⑤ You can breathe in naturally after breathing out.
⑥ Again, breathe in and out deeply, easily, andcomfortably.
⑦ Imagine that you are relieved from tiredness andnervousness when you breathe out.
⑧ Continue in your own pace for awhile.
～ after about a minute ～⑨ Stretch out your whole body.
Move your neck and shoulders, and move both legs.
Breath relaxation is over.

Self-careA relaxation method for shoulders (sitting on a chair )① Raise yourshoulders
straight while
sitting on a chair.
Take care not tobend your back.

②Raise shoulders
until they startfeeling tense,slowly count from
1 to 5 while
breathing in andout slowly.

③ Then, lower
your shoulders,
while counting
from 1 to 10.

④ Keep yourshoulders down
for a while.
Feel your bodyrelax. Do thispractice two or
three times.

A relaxation method for upper parts of the body( sitting on a chair )① Make fists on
your knees.
Clench fists.
⇒Tense themuscles in yourhands andforearms. Pay
attention to thefeeling of strength.

② While firmly keeping
the strength in yourarms, bend your elbows
and bring them close toyour body.
⇒Keeping the muscles inyour arms tense, pay
attention to the feelingof strength.

③ While keeping thestrength in your arms,tense your shoulders
and raise them straight.
⇒ Keeping the power inyour arms andshoulders, pay
attention to the feelingof strength.

④ While keeping
your shoulders up,
expand your chesta little.
⇒Pay attention to
the feeling ofstrength in yourwhole upper body.

⑤ Count slowly from
1 to 5, keeping yourupper body as it is.
Don’t hold yourbreath.
Pay attention to thefeeling of strength.

⑥ Relax your upper
body quickly. Pay
attention to the soft
feeling after relaxing.
After relaxing, stay
like this while feelingyour body for a while(about a minute).

Finish with a refreshed feeling● Form the signs rock, paper,rock, and paper, again andagain. Bend and stretch yourarms several times.

● Stretch yourwhole body.
Stretch yourarms and legs
and feelrefreshed.

☑ Point
If children become uneasy instead of relaxing, don't force or scold them. Say something
like “Try this when you think you can do it,” or “It would be nice to find a better method.”Mental Care for Children after Disasters for Teachers and School Nurses（Mental Care Committee after disasters in Shizuoka Clinical Psychologist Association）

Coauthors
Tomoko Kobayashi, Ph.D
Professor at Shizuoka University
Masamichi Nakagaki
Shizuoka Prefecture Ｆuji Child Guidance Center
Yayoi Yoshinaga
Shizuoka-City Child & Youth Counseling Center
Hisako Imaki
Shizuoka Prefecture Yoshiwara School（School for Mentally Disabled Children)
Yasuyuki Nagashima
Mitagahara Hospital
Reiko Ishikawa
Shizuoka Prefecture School CounselorIllustratedby Tomoko Takahashi, Professor at Shizuoka University
Mistuko Miwa, Ryosuke Takahashi, Hitomi Nagashima, EriYamashita, students at Shizuoka
University

English translation
by Shizuno Seki, Lecturer at Shizuoka University
Takako Kozima, Lecturer at Shizuoka University
Heike Walter, International student at Shizuoka University from Bonn University
Nicholas Gran, International student at Shizuoka University from University of Nebraska - Omaha

In cooperation with Yoshinari Hayashi,Ph.D Shizuoka University Disaster Prevention Center© Copyright 2010 by Mental Care Committee after disasters in Shizuoka Clinical Psychologist AssociationPublished 2010 by Shizuoka University Disaster Prevention Center
836 Ohya Surugaku Shizuoka city, Shizuoka prefecture 422-8529, Japan